Asian Journal of Transfusion Science
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ORIGINAL ARTICLE  
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Knowledge, attitude, and practice toward blood donation and transfusion and associated factors among the adult population of Gondar town


1 Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
2 Department of Medical Laboratory Science, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

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Date of Submission24-Dec-2021
Date of Decision18-Jul-2022
Date of Acceptance31-Jul-2022
Date of Web Publication12-Dec-2022
 

   Abstract 

BACKGROUND: The current demand and actual supply of blood in developing nations are under swing imbalance. Blood donations have been hampered by societal misconceptions and lack of awareness regarding blood and blood donations. Therefore, the study aimed to assess the knowledge, attitude, and practice about blood donation and transfusion and associated factors among the adult population in Gondar town.
MATERIALS AND METHODS: A community-based cross-sectional study was conducted from July to August 2021 in Gondar town. Multistage sampling technique together with a random sampling technique was used to select study participants. Data were collected using a structured questionnaire via face-to-face interviews. Binary logistic regression was done to identify associated factors. P < 0.05 was considered statistically significant.
RESULTS: Of 826 participants, 90.1% and 79% of the respondents had good knowledge and favorable attitude toward blood donation, respectively. About 35.4% of participants had an experience of practicing blood donation. Regarding blood transfusion, 27.5% of respondents had a history of transfusion by their own or their family members. Overall, 75% and 83.5% of participants had good knowledge and favorable attitude toward blood transfusion, respectively. Being a government employee, student, health worker, having good knowledge and favorable attitude toward donation were significantly associated with blood donation practice. While the level of education and occupational status were significantly associated with the level of knowledge about blood donation.
CONCLUSION: The level of blood donation practice was low. Therefore, organizing intensive blood donation campaigns and regularly intervention on the barrier of donation practice should be maintained at the community level.

Keywords: Attitude, blood donation, blood transfusion, Gondar, knowledge, practice


How to cite this URL:
Gelaw Y, Zayede A, Wudie A, Aklilu A, Dawit R, Mekuria A, Getawa S. Knowledge, attitude, and practice toward blood donation and transfusion and associated factors among the adult population of Gondar town. Asian J Transfus Sci [Epub ahead of print] [cited 2023 Jan 28]. Available from: https://www.ajts.org/preprintarticle.asp?id=363224



   Introduction Top


The need for blood donation is constantly increasing globally, but only a small percentage of the population in many parts of the world understands, accepts, and practices it.[1] Blood transfusion is an essential component of health care that saves millions of lives, but it remains difficult for many people who require safe and timely transfusions.[2] Despite considerable efforts and a variety of blood donation programs around the world, adequate and safe blood still remains inadequate to satisfy the rising demand, particularly in developing countries.[3]

Evidence showed that a total of 118.5 million blood donations are collected globally and 40% of these are collected in high-income countries. The blood donation rate per 1000 people is 31.5 donations in high-income countries, 15.9 donations in upper-middle-income countries, 6.8 donations in lower-middle-income countries and five donations in low-income countries.[4] The rate of blood donation in low-income countries is still low. Fear, lack of understanding, and inconvenience with facilities such as infrastructure, time, distance, sociocultural background, and health status, were factors.[5],[6] Furthermore, the high prevalence of some infectious diseases; such as hepatitis B, C, and HIV are the challenges for the selection of donors.[5] Currently, the COVID-19 pandemic adversely affects blood donation activities and subsequently reduces the supply and demand of blood and blood components.[7] World Health Organizations estimated that the COVID-19 pandemic caused a 20%–30% reduction of blood supply in its six regions, and the donor attendance rate has fallen by 10%–30% in the state of Washington and by 30% in Canadian blood bank service.[8],[9]

The availability and safety of blood still remain inadequate to meet the increased demand of blood and blood components, particularly in Sub-Saharan Africa like Ethiopia.[3],[5] In Ethiopia, societal misconceptions as well as a low level of awareness about blood and blood donations, have hindered voluntary blood donations. The Ethiopian National Blood Bank collects nearly 200,000 units of blood from donors annually. The country requires 18,000 units of blood daily, yet the average daily amount collected is approximately 1100 units, which results in a shortfall of 16,900 units of blood.[10]

Even though blood transfusion is a safe medical procedure, growing evidence suggests that the public views it as a risky process.[11],[12],[13] Lack of awareness and attitude of the patient toward blood transfusion continues to be a real threat to the procedure.[14],[15] The intention of the population toward voluntary blood donation is poorly assessed in developing countries including Ethiopia. Even though studies have been done on knowledge, attitude, and practice (KAP) toward blood donation previously, the community KAP toward donation and transfusion has changed over time. Therefore, this study aimed to assess the knowledge, attitude, and practice toward blood donation and transfusion among adult populations in Gondar town.


   Materials and Methods Top


Study design, period and setting

A community-based cross-sectional study was conducted from July to August 2021. The study was conducted in population residing in Gondar town, Northwest Ethiopia. The town is found in the central Gondar zone, Amhara Regional State. It is located 738 km far from the capital city, Addis Ababa and 180 km far from the capital city of the region Bahir Dar. It was estimated that the 362,000 population lived in Gondar town in 2020.[16] The town is divided into 24 kebeles, 12 of which are classified as subcities, 11 as rural kebeles, and one as a special Kebele.[17]

Source and study population

All population who are residing in Gondar town for at least for 6 months was the source population. While adult population who are residing in Gondar town at least for 6 months and who are available during the study period and willing to participate in the study was considered as the study population. All adult population who are aged ≥18 years old living in Gondar town was included in the current study but adults who are critically ill were excluded from the study.

Variables of the study

Knowledge, attitude, and practice toward blood donation and blood transfusion were the dependent variables of the study while sociodemographic characteristics including age, sex, marital status, religion, educational status, and occupational status were the independent variables of the study.

Sample size determination

A single population proportion formula (n = [(Zα/2)2 P (1 − p)]/d2) was used to determine the sample size for the study. The sample size was determined by taking the prevalence of good knowledge (56.8%) toward blood donation from the previous conducted study in Ethiopia.[18] The sample size is calculated as follows: N = (Z α/2)2 P (1 − p)/d2. = ([1.96]2 × 0.568 [1 − 0.568])/(0.05)2 = 377. Where, d = margin of error between the sample and the population (d = 5%), N = final sample size, P = prevalence (56.8%) and Zα/2 = 95% confident interval (1.96). By adding 10% nonresponse rate, the sample size was 415 and multiplied by 2 design effects then final sample size becomes 830.

Sampling technique and procedure

Multistage sampling technique together with random sampling technique was employed to select study participants. At stage one four sub-cites were selected from the total of 12 subcites of the town by lottery method. At stage two, eight kebeles were selected from a total 24 kebeles of the town using systematic random sampling technique. Finally, the lottery method was employed to select one study participant from the households with more than one eligible individual [Figure 1].
Figure 1: Schematic diagram of sampling procedure

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Data collection tool and procedure

Pretested structured questionnaire prepared in the Amharic language was used in gathering relevant information. Data on knowledge, attitude, and practice concerning blood donation and transfusion were collected using a questionnaire that was used previously in Ethiopia and amended based on the reviewed literature.[18],[19],[20],[21] The data collection tool is designed to obtain information about sociodemographic characteristics, knowledge, attitude, and practice of the community about blood donation and transfusion. The questionnaire consists of 6 socio-demographic questions, 22 knowledge assessing questions, 8 attitude assessing questions, and 7 practice questions about blood donation and transfusion. The correct response was scored as “1” and the incorrect answer was scored as “0” for analysis. The data were collected via face-to-face interview by data collectors.

Data quality measures

The questionnaire was prepared in English and translated into Amharic language and re-translated back to English to see the consistency of the questionnaire. The questionnaire was pretested on 5% of the sample size to ensure its validity. To assure quality, the questionnaire was checked for its clarity, understandability, and completeness based on objectives and variables before to the actual data collection. Close supervision was conducted during the data collection period. Cronbach's alpha reliability coefficients were calculated to determine the internal consistency of the questionnaires: a Cronbach's alpha of 0.7 or higher indicates high reliability, a Cronbach's alpha of 0.5–0.7 suggests moderate reliability, and < 0.5 indicates low consistency. Cronbach's alpha values were 0.63, 0.68, and 0.71 for the KAP constructs, respectively.

Statistical analysis

Data were entered into Epi-data version 4.4.3.1(EpiData Association, Odense, Denmark) statistical software and then exported to the Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corporation, Armonk, NY, USA). Descriptive statistics such as mean, frequency, and the percentage were used to summarize the characteristics of the study population. Both bi-variable and multivariate binary logistic regression analyses were performed to identify associated factors of KAP toward blood donation and transfusion. The strength of the association was assessed by computing the crude odds ratio and the adjusted odds ratio (AOR) with a 95% confidence interval (CI). P < 0.05 was considered statistically significant.

Operational definitions

Good score: those who score 50% and above for knowledge and attitude assessing questions were categorized as “good knowledge” and “favorable attitude”, respectively. Having at least one history of blood donation and transfusion was used to label them as having practice.[6],[18]

Ethical consideration

The study was conducted after obtaining ethical clearance letter from the Ethical review committee of the School of Biomedical and Laboratory Sciences University of Gondar (Re. No./SBMLS/2896/2013). Besides, letters of permission were secured from the administrative bodies and coordinators from the Gondar town. The objective of the study was explained for each candidate participant and written informed consent was obtained from each study participant. The data collected from each participant were kept confidential, and the names of the responders were not recorded.


   Results Top


Sociodemographic characteristics

A total of 830 study participants with a response rate of 99.52% were included. The mean ± standard deviation age of the study participants was 27.01 ± 7.612 years with a range of 18–65 years. Out of the study participants, 505 (61.1%) were male. Of the participants, 559 (67.7%) were single in their marital status and 335 (40.6) were students in their occupation. More than half 461 (55.8%) have a diploma and above in their educational status. The majority, 688 (83.3%) were orthodox Christian, followed by Muslim 106 (12.8%) in their religion [Table 1].
Table 1: Sociodemographic characteristics of study participants for the knowledge, attitude and practice towards blood donation and transfusion in Gondar town, Northwest Ethiopia, 2021

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Participant knowledge toward blood donation and transfusion

Of the total, 783 (94.8%) of study participants heard about blood donation from different information sources. More than half of the participants, 429 (51.9%) know their blood group. Half, 415 (50.2%) of the participants correctly respond that the period of donating blood. Moreover, 766 (92.7%) of the study participants were aware of which age group can donate blood. Out of all participants, 731 (88.5%) argued that volunteer type of blood donation is the best source of blood. Meanwhile, majority of 695 (84.1%) of the study participants know that HIV-positive individuals cannot donate blood. More than two-thirds, 658 (79.7%) of the study participants know that blood donation does not have harm to donors. Overall, 90% (95% CI: 88%–92%) of the study participants expressed good knowledge toward blood donation [Table 2].
Table 1: Sociodemographic characteristics of study participants for the knowledge, attitude and practice towards blood donation and transfusion in Gondar town, Northwest Ethiopia, 2021

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Participants were also interviewed regarding their level of knowledge about blood transfusion. Out of the participants, 641 (77.6%) of them had information about blood transfusion. Majority, 472 (57.1%) of participants responded that health workers were their main source of information about blood transfusion. More than half, 475 (57.5%) had known blood is transfused intravenously. Most of the participants, 661 (80%) know the reason why blood is transfused. Of the participants, 656 (79.4%) argued that blood transfusion is practiced to save a life. Meanwhile, 227 (27.2%) of the study participants answered that transfusion is harmful. In general, 75% (95% CI: 72%–78%) of the study participants expressed good knowledge toward blood transfusion [Table 3].
Table 3: Proportion of respondents towards knowledge indicators about blood transfusion among adult populations in Gondar town, Northwest Ethiopia, 2021

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Source of information about blood donation

Study participants were asked about their source of information about blood donation. Most of the respondents (53.8%) heard from health workers, followed by television (43.3%), and a few numbers of respondents heard from the newspaper, followed by relatives [Figure 2].
Figure 2: Respondent's source of information about blood donation

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Eligibility criteria for donation

From the noneligible criteria for blood donation presented, most respondents (62%) know that individuals with infectious disease not eligible for blood donation, followed by pregnant and lactating women (50.1%) [Figure 3].
Figure 3: Respondent's knowledge on noneligible criteria for blood donation

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Participant attitude toward blood donation and transfusion

Of the total, 770 (93.2%) of study participants think that blood donation is an important act. Most, 659 (79.8%) of the participants were voluntary for donating blood and more than half, 423 (51.2%) argued that blood bank does not sell blood. In general, 79% (95% CI: 76%–82%) of study participants expressed a good attitude toward blood donation. Regarding blood transfusion, 710 (86.0%) of participants thought that blood transfusion is important and 662 (80.1%) agreed to transfused if required for medical intervention. Majority, 565 (68.4%) of participants believed that blood transfusion was accepted by their religion. Overall, 83.5% (95% CI: 81%–86.1%) of the study participants expressed a favorable attitude toward blood transfusion [Table 4].
Table 4: Proportion of respondents towards attitude indicators about blood donation and transfusion among adult populations in Gondar town, Northwest Ethiopia, 2021

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Blood donation and transfusion practice

Out of 826 study participants, 35.4% (95% CI: 32%–39%) of the study participants had an experience practicing blood donation. From participants that donated blood, 187 (22.6%) donate blood once per year and 234 (28.3%) was voluntary. Furthermore, participants interviewed about the reason why they cannot donate blood; 273 (33.1%) fear that donation may cause anemia, followed by fear of weight loss 112 (13.6%) as possible reasons. Regarding transfusion, 227 (27.5%; 95% CI: 24%–31%) had a history of transfusion by their own or their family member and 157 (72.5%) were transfused for once [Table 5].
Table 5: Proportion of respondents towards practice about blood donation and transfusion among adult populations in Gondar town, Northwest Ethiopia, 2021

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Associated factors of knowledge about blood donation and transfusion

After adjusting potential independent variables, multivariable analysis affirmed being a government employee (AOR: 3.05; 95% CI: 1.13–8.27) were significantly associated with good knowledge about blood donation. However, participants who were unable to read and right had a preventive factor for good knowledge about blood donation (AOR: 0.22; 95% CI: 0.08–0.57) [Table 6]. However, being male (AOR: 1.79; 95% CI: 1.27–2.54) were significantly associated with good knowledge about blood transfusion. Besides, participants who were unable to read and write (AOR: 0.30; 95% CI: 0.14–0.69) and participants who were able to read and write (AOR: 0.57; 95% CI: 0.36–0.89) were identified as preventive factor for having good knowledge about blood transfusion [Table 7].
Table 6: Factors associated with knowledge toward blood donation among adult populations in Gondar town, Northwest Ethiopia, 2021

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Table 7: Factors associated with knowledge toward blood transfusion among adult populations in Gondar town, Northwest Ethiopia, 2021

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Factors associated with attitude and practice about donation

Variables that were statistically associated with participants favorable attitude toward blood donation were only having good knowledge (AOR: 1.98; 95% CI: 1.19–3.29) [Table 8]. Besides, being government employee (AOR: 2.33; 95% CI: 1.17–4.62), being student (AOR: 2.27; 95% CI: 1.18–4.38), being a health worker (AOR: 4.98; 95% CI: 1.45–17.14), having good knowledge (AOR: 1.83; 95% CI: 1.05–3.19) and having a good attitude toward donation (AOR: 2.01; 95% CI: 1.36–2.97) were significantly associated with good practice toward blood donation [Table 9].
Table 8: Factors associated with attitude toward blood donation among adult populations in Gondar town, Northwest Ethiopia, 2021

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Table 9: Factors associated with blood donation practice among adult populations in Gondar town, Northwest Ethiopia, 2021

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   Discussion Top


For many patients, blood transfusion is a lifesaving procedure and one of the most important aspects of modern health care.[22] The current study was conducted to investigate the level and factors associated with KAP of adult populations toward blood donation and transfusion in Gondar town. About half of the study participants are aware that they can donate blood every 3 months. This was higher than a study conducted in Mekelle town (33.6%),[23] but similar to the study conducted in Debre Markos town (53.8%).[6] Majority (88%) of the participants reported that voluntary blood donation was the best source of blood, which was slightly higher than studies conducted in Gondar town (85.2%),[18] and slightly lower than other studies conducted in Debre Markos town (96.6%).[6] Overall, about 90% (95% CI: 88%–92%) of participants had adequate knowledge about blood donation, which was higher than a community-based study conducted in Gondar town (56.8%),[18] Debre Markos town (56.5%),[6] Jigjiga town (61.2%),[19] Adama town (47%),[24] and Mekelle town (49%).[23] The possible reason for the discrepancy might be the time gap of the study conducted. Moreover, the current situation in the country which is more wars, conflicts, and accidents increases the need for blood. This, in turn, motivates the mass media, social media, health centers, campaigns, banners, telephone SMS, and others to give information about blood donation for the community this enhances the level of knowledge about blood donation.

Participants who cannot able to read and write were 78% less likely knowledgeable about blood donation (AOR: 0.22; 95% CI: 0.08–0.57). The observation of knowledge about blood donation being directly proportional to the education levels seems to be logical since education would increase awareness about all possible information addressed by social media, different banners and telephone messages related to blood donation.[25] Being a government employee was 3.05 times more knowledgeable than other occupations (AOR: 3.05; 95% CI: 1.13–8.27). This finding was similar to a study conducted in Jigjiga town.[19] The possible reason might be most of the government employee individuals are educated thus, they have the ability to easily understand information.

Regarding their attitude, 79% (95%CI: 76%–82%) of the study participants expressed favorable attitude toward blood donation. This finding was similar to previous studies done in Gondar (82%) and Jigjiga town 78.1%,[18],[19] and higher than studies conducted in Bibir town (45.2%),[21] and Debre Markos town (68%).[6] More than three-fourth of respondents were voluntary for donating blood. The finding was similar to previous studies conducted on health professionals and medical students.[26],[27] This can be interpreted as that altruism is the main factor for blood donation. Having good knowledge toward blood donation was significantly associated with the level of attitude toward blood donation (AOR: 1.98; 95% CI: 1.19–3.29). The result was similar to the finding of the study done in Debre Markos town which reported that blood donation knowledge is an independent predictor of attitude.[6] The possible reason might be having good knowledge regarding blood donation change the intention and beliefs of an individual about the great importance of blood donation.

About 35% of respondents reported at least one history of blood donation which was comparable with a previous study conducted among health-care workers (33.9%).[28] However, the finding is higher than previous studies reported in Gondar town (18.4%),[18] Debre Markos town (16.1%),[6] Harar town (22.6%),[29] and Jigjiga town (18.9%),[19] but it was lower than a study conducted in Jordan (68.8%).[30] The difference could be due to a difference in sample size or a time interval between the studies. Having good knowledge and favorable attitude toward blood donation were significantly associated with blood donation practice. This was in line with previous studies done in Ethiopia,[6],[24],[31] Pakistan,[32] and Saudi Arabia.[33] This might be because people who are knowledgeable about blood donation are more aware of the importance of blood in saving the lives of patients and are motivated and altruistic to donate blood.[31]

We attempted to determine the community's degree of knowledge and attitude concerning blood transfusion. Accordingly, 472 (57.1%) of participants responded that health workers were their main source of information about blood transfusion. The finding was in line with the previous study done at Kampala international university-teaching hospital which reported that the majority of respondents acquired knowledge of blood transfusion from health centers, followed by television and the least was from the Internet.[15] Therefore, there is a requirement to create additional educational platforms and programs on blood donation and blood transfusion including the Internet. More than half, 475 (57.5%) of respondents know that blood is transfused intravenously which is lower than a previous study which reported 80%.[34] Overall, 75% (95% CI: 72%–78%) of the study participants expressed good knowledge toward blood transfusion. This finding was higher than the finding of a study conducted in Southwestern Nigeria (41.3%).[34] The possible reason for the variation might be related to the difference in the study period, study population, sample size, and study area. Participants who cannot able to read and write were 70% less knowledgeable than another educational status (AOR: 0.30; 95% CI: 0.14–0.69). The possible reason might be the low level of understanding of information addressed by health-care workers, posters, and newspapers related to transfusion.

In the current study, 710 (86.0%) of participants thought that blood transfusion is important and 662 (80.1%) were voluntary for being transfused if required for medical intervention. In line with a study done by Oriyomi et al. showed that 80% of the respondents are ready to accept blood transfusion, while 20% will refuse blood transfusion.[34] Similarly, a study by Al-Drees in Saudi Arabia showed that 20% of respondents stated that they would refuse blood transfusion even if they were in need because of the risk of acquiring infectious disease while the remaining were ready for being transfused.[20] Majority, 68.4% of participants believed that blood transfusion was accepted by their religion, while the remaining 31.6% believed that being blood transfusion is not allowed by religion. Similarly, a study by Oriyomi et al. reported that 12.8% of respondents refuse blood transfusion due to religious beliefs.[34]

This study was the first study which assesses the level of KAP toward blood transfusion in the study area may be counted as strength. However, the study has its limitation. One of the limitations of this study comes from the cross-sectional nature of its design which limits the study to show a causal association. Too many blood donation campaigns in the media and on other platforms during the data collection process could overstate the study's findings.


   Conclusion Top


The proportion of adults who had an adequate level of knowledge and a favorable attitude toward blood donation and transfusion was high. However, the level of blood donation practice was low. Participants agreed that the best source of blood came from volunteers, and blood was transfused to save the patients' lives. Lack of opportunity, religion, fear of anemia, and weight loss were mentioned as a reason for not donating blood. Thus, hospitals and blood bank centers should prepare donation campaigns regularly in a place where the community is able to reach.

Abbreviations

KAP: Knowledge, attitude and practice, AOR: Adjusted Odd Ratio, CI: Confidence Interval, COR: Crude Odd Ratio, SD: Standard Deviation, WHO: World Health Organizations

Acknowledgments

We would like to acknowledge the University of Gondar, College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences for their logistic support to conduct the study. Besides, the authors thank all individuals who participated during data collection and each study participant for their cooperation to participate in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Correspondence Address:
Solomon Getawa,
Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar
Ethiopia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajts.ajts_190_21



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2006 - Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow
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